Job Description

We take great strides to ensure our employees have the resources to live well, be healthy, continue learning, develop skills, grow professionally and serve our local communities. We invite you to apply for a career with Blue Cross.

Residency in or relocation to Louisiana is preferred for all positions.

POSITION PURPOSE

This position is responsible for personnel administration including selection, coaching, motivation, discipline, continuous improvement and compliance This position is responsible for managing complex behavioral health inpatient and outpatient cases, prospective and retrospective review cases, claims review, accurate administration of benefits, and appeals and grievances.

How You Contribute to the Company’s Mission in this Role:

• Manages strategic planning designed to achieve departmental, divisional and/or company goals. Serves on corporate committees/project teams to design and implement customer and/or provider service programs that support corporate initiatives and Behavioral Health Operational Objectives.

• Manages multiple staff level positions by administering all HR functions, including but not limited to, hiring, terminating, conducting performance reviews, managing work schedules, managing a budget, assigning and directing workload, training and developing staff, coaching, etc. to help ensure departmental, divisional and/or corporate goals are set and obtained.

• Plans, documents, and analyzes workflows, policies and activities to ensure proper documentation, tracking, auditing, and analysis of work efforts. Maintains documentation of program and quality improvement activities in required formats for accreditation/regulatory bodies.
• Develops and manages peer relationships in other divisions across the company to help ensure that all areas of member touch points are engaged and work to improve member and/or provider satisfaction.
• Resolves non-routine issues with appropriate internal and/or external audiences to ensure appropriate resources are allocated and available to provide customer service that aligns with departmental, divisional and/or corporate goals.
• Analyzes system usage to identify problems, design, test, and initiate changes, as well as improve, develop and implement processes with appropriate departments to ensure optimal system design and usage.
• Reviews and develops policies and procedures with appropriate internal and/or external audiences to manage service level agreements, quality assurance and timeliness to ensure compliance, consistency, effectiveness and efficiency across all assigned units.

Required Qualifications:

• Bachelor’s in behavioral health related field, nursing, business management, healthcare administration or a related field
• 5 years of experience in a behavioral health environment analyzing policies and procedures, improving operational processes and providing proactive service solutions with 2 years of leadership experience
• Strong analytical, organizational, management, communication and interpersonal skills required.

• Ability to make decisions, prioritize, find solutions, and work independently.

• Working knowledge of relevant PC software, and proficient in Microsoft Office suite.
• Strong knowledge of the Behavioral Health service delivery continuum.

Preferred Qualifications:

• Experience managing staff with direct reports.
• Leadership experience in a behavioral health organization.
• Experience using phone technology or forecasting to establish staffing needs.
• Working knowledge of claims billing code sets is strongly preferred.
• Experience and knowledge of Epic systems and program development.

The Physical Demands described here are representative of those that must be met by an employee to successfully perform the Accountabilities and Essential Functions of the job. Reasonable accommodations may be made to enable an individual with disabilities to perform the essential functions

• Perform other job-related duties as assigned, within your scope of responsibilities.
• Job duties are performed in a normal and clean office environment with normal noise levels.
• Work is predominately done while standing or sitting
• The ability to comprehend, document, calculate, visualize, and analyze are required.

An Equal Opportunity Employer

All BCBSLA EMPLOYEES please apply through Workday Careers.

PLEASE USE A WEB BROWSER OTHER THAN INTERNET EXPLORER IF YOU ENCOUNTER ISSUES (CHROME, FIREFOX, SAFARI)

Additional Information

Please be sure to monitor your email frequently for communications you may receive during the recruiting process. Due to the high volume of applications we receive, only those most qualified will be contacted. To monitor the status of your application, please visit the "My Applications" section in the Candidate Home section of your Workday account.

If you are an individual with a disability and require a reasonable accommodation to complete an application, please contact recruiting@bcbsla.com for assistance.

In support of our mission to improve the health and lives of Louisianians, Blue Cross encourages the good health of its employees and visitors. We want to ensure that our employees have a work environment that will optimize personal health and well-being. Due to the acknowledged hazards from exposure to environmental tobacco smoke, and in order to promote good health, our company properties are smoke and tobacco free.

Blue Cross and Blue Shield of Louisiana performs background and pre-employment drug screening after an offer has been extended and prior to hire for all positions. As part of this process records may be verified and information checked with agencies including but not limited to the Social Security Administration, criminal courts, federal, state, and county repositories of criminal records, Department of Motor Vehicles and credit bureaus. Pursuant with sec 1033 of the Violent Crime Control and Law Enforcement Act of 1994, individuals who have been convicted of a felony crime involving dishonesty or breach of trust are prohibited from working in the insurance industry unless they obtain written consent from their state insurance commissioner.

Additionally, Blue Cross and Blue Shield of Louisiana is a Drug Free Workplace. A pre-employment drug screen will be required and any offer is contingent upon satisfactory drug testing results.